Why to Use
Pediatric stroke is relatively uncommon, but it remains an important cause of morbidity and mortality in children. Adult stroke scales have limited sensitivity when applied to pediatric populations (62%-67% sensitivity according to an analysis by Mackay et al ). The PedNIHSS is up to 87% sensitive (Beslow 2012). It quantifies the severity of pediatric stroke and can be trended over time to assess recovery, while the initial score may be predictive of future disability at 90 days.
When to Use
The PedNIHSS should be used in pediatric patients aged ≥ 2 years who have clinical and radiologic signs of acute ischemic stroke.
In order to improve the accuracy of the PedNIHSS, the patient’s family members should be instructed to refrain from hinting at the correct responses to the questions asked.
Abbreviation: tPA, tissue plasminogen activator.
Derek Tam, MD, MPH
Pediatric patients with sickle cell disease who present with acute ischemic stroke will likely benefit from emergent blood transfusion to reduce hyperviscosity. Early consultation with a pediatric hematologist, in addition to a pediatric neurologist, is recommended for these patients.
Pediatric stroke is rare, and the true predictive value of the PedNIHSS is subject to change as the scale continues to be studied. Retrospective application of the PedNIHSS has been shown to be valid and reliable in 1 cross-sectional study (Beslow 2012).
The PedNIHSS was developed by expert consensus of a panel of adult and pediatric stroke experts (Ichord 2011). The panel adapted the validated adult NIHSS to be appropriate for age-related variations in the comprehension of examination materials. The scoring strategy and ranges were not changed. The panel evaluated the interrater reliability of the PedNIHSS among 113 patients aged 2 to 18 years in a multicenter prospective cohort study. Overall, the interrater reliability was found to be quite high, ranging from 0.63 to 1.00 among the evaluating pediatric neurologists.
The PedNIHSS was externally validated by applying it to 75 children enrolled in a prospective study (Beslow 2012). Patients were scored both prospectively and retrospectively (based on the chart). Retrospectively applied scores correlated well with prospective scores (r2 = 0.76). Interrater reliability was good overall (intraclass correlation coefficient of 0.95; 95% confidence interval, 0.94-0.97), with similar findings for individual test items.
Rebecca N. Ichord, MD
Amy Buckowski, MD; Emily Rose, MD, FAAP, FAAEM, FACEP
Lauren A. Beslow, MD, MSCE, FAHA; Meghan Gilley, MD, FRCPC
December 15, 2019
December 15, 2022